Noridian October coding updates change FFR, infusion-pump and SAD billing
Oct 4, 2026 edition · GC-2026-0201 · Published 2026-10-04 · Version 2 · Final
Noridian’s October 1 notices separately update FFR codes, infusion-drug pricing, a SAD exclusion and diagnosis-code lists.
What happened
Noridian’s October 1 JE notices add 1086T, 1087T and 1104T to noninvasive fractional-flow-reserve article A58095. Infusion-pump article A55239 revision 27 updates Prialt/ziconotide and ropivacaine pricing for October 1–December 31 under the quarterly ASP file. Self-administered-drug article A53032 revision 48 deletes J1941 from its excluded-code list. Those notices describe different coding, pricing and exclusion-list changes; deletion from the SAD list alone does not establish that every patient, service setting or claim meets all remaining coverage and payment conditions.
The same-day ICD-10 notice adds, removes or revises diagnosis codes across multiple articles, including cardiac testing, imaging, rehabilitation, laboratory and wound care. Some changes replace broader codes with more specific descendants, so retaining an old code without checking its article and service date can misalign local edits. As of October 4, the notices are effective, but the full relevant article and underlying benefit or coverage policy still determine a claim’s treatment. Teams should verify the implemented version and the particular procedure, drug and diagnosis rather than apply one global rule to all four updates.
Scope and timing
- Authority status
- Final
- Applicability
- Operationally relevant
- Audience
- Health systems, Provider networks
- Jurisdiction
- Federal
- Affected functions
- Revenue Cycle, Compliance, Clinical Operations
- Responsible owner
- Revenue Cycle
- Recorded date
- 2026-10-01
- Date type
- effective
Why it matters
A shared effective date can conceal different changes that need separate clinical, code-table and pricing validation.
Recommended action
Verify affected October procedure, diagnosis and price tables against each article and benefit rule, including the limits of the SAD deletion, and reconcile representative claims.
Implementation playbook
- Update affected code and price tables and validate billing against each complete policy and benefit rule. Revenue Cycle · Due 2026-10-09
- Record the applicability assessment and validate the affected workflow with its operational owner. This is an internal review target, not an additional statutory deadline. Compliance · Due 2026-10-12
Sources
- October CPT and HCPCS billing article updateOfficial · Noridian Medicare · 2026-10-01 · Source review 2026-10-04
- Implantable infusion pumps article R27Official · Noridian Medicare · 2026-10-01 · Source review 2026-10-04
- Self-administered drug exclusion list R48Official · Noridian Medicare · 2026-10-01 · Source review 2026-10-04
- October ICD-10 billing article updatesOfficial · Noridian Medicare · 2026-10-01 · Source review 2026-10-04
- Official retained source documentOfficial · Official issuing agency · Source review 2026-10-16
Complete edition and supplemental material
This finding in the complete approved report →Regulatory horizons, CIA trends and implementation trackers remain in the full report.
Read the entire Medicare & Medicaid report →